Hope for Healing: Miscarriage and the Dignity of the Human Body Andrew J. Sodergren, M.S. Abstract This paper examines the issue of miscarriage from the perspective of the mother-child couplet. A discussion of the psychology of motherhood and miscarriage highlights the negative impact miscarriage has on the mother. Mothers must be helped to mourn the irreplaceable child lost in miscarriage. A review of Catholic teaching on the human body and dignity of the unborn emphasizes the respect owed to pre-natal human life and the bodies of embryos and fetuses who have died. Finally, it is argued that holding a funeral/burial is the best possible way to assist the mother’s grieving and to respect the deceased child. Current practices and attitudes fail to recognize either of these norms. Hope for Healing: Miscarriage and the Dignity of the Human Body Catholic bioethicists today are continually confronted with a number of pressing issues raised by the culture of death and new medical technologies: stem cell research, cloning, frozen embryos, reproductive technologies, euthanasia, and the like. While it is necessary that scholars and Church officials devote their energies to responding to these many new challenges, a regrettable consequence of this is that less controverted, more mundane issues are sometimes overlooked. When this happens, people are left without sound ethical guidance and support for dealing with situations in their lives. This is precisely the case with miscarriage, a very common and morally delicate event that has received little attention. Central to the issue of miscarriage is the care due to the two people most affected by it: the mother and her unborn child. This paper will thus examine the proper care due to the mother-child couplet. [1] To begin, I examine the psychology of motherhood and miscarriage to provide a human context from which to evaluate any interventions aimed at the mother. Following this, I review Catholic teaching on the human body, care of human corpses, and the dignity of the unborn. Finally, these two lines of thought are integrated, showing that the good of the deceased child and the good of the mother converge. I argue that in light of the substantial grief experienced by the mother and Catholic teaching on the human body, holding a funeral and dignified burial for a miscarried child is the best possible response to such a tragedy. Obstacles preventing the implementation of this response to miscarriage are also discussed. Motherhood and the Psychology of Miscarriage Defined in the professional literature as “the spontaneous termination of an intrauterine pregnancy prior to 28 weeks of gestation resulting in fetal death,” miscarriage “is fairly common, occurring in 10-20% of clinically recognized pregnancies” (Geller, Kerns, & Klier, 2004, p. 35). [2] Researchers have noted, “In the United States in the 1990s, approximately half a million women miscarry annually” (Neugebauer, Kline, Shrout, Skodol, O’Connor, Geller, Stein, & Susser, 1997, p. 383). Approximately 80% of these deaths occur in the first trimester, i.e., conception to 13 weeks (Maker & Ogden, 2003). Thus, miscarriage (also known as “spontaneous abortion”) occurs much more frequently than most people realize, especially in the early phase of pregnancy. The primary medical treatment for miscarriage is dilation and curettage (D&C) (Geyman, Oliver, & Sullivan, 1999). This involves the dilation of the cervix and the surgical removal of the deceased baby and associated structures. This procedure is utilized to ensure that that none of the child’s tissue remains in the uterus increasing the risk of infection 1 and blood loss (McCartney & van der Meer, 1990). It is a quick, outpatient procedure (Kohn & Moffit, 2000) with a high success rate—though not without risks such as damage to or perforation of the uterus. However, it should be noted that Geyman et al. (1999) reviewed the extant literature on treatment of first trimester miscarriage and found that expectant therapy (waiting for the miscarriage to resolve itself naturally) had a success rate approximately equal to D&C. They recommend this treatment in conjunction with transvaginal sonography to ensure that all fetal tissue has been passed. Likewise, Kippley & Kippley (1996) argue from their consultations with experts that D&C is often not medically necessary. Nonetheless, elective D&C has remained the typical manner of treating early miscarriage. Despite the relative brevity of most pregnancies ending in miscarriage noted above, these losses can be devastating for the women who experience them. Before discussing the research illustrating this pain, it is helpful to explore why miscarriage is a particularly painful event for women. This question is best answered by reviewing the Christian vision of motherhood Pope John Paul II offers in his apostolic letter Mulieris Dignitatem and elsewhere. In his discussions of motherhood, the Pope never fails to provide a proper anthropological grounding: The human being - both male and female - is the only being in the world which God willed for its own sake. The human being is a person, a subject who decides for himself. At the same time, man “cannot fully find himself except through a sincere gift of self”…. This definition of the person corresponds to the fundamental biblical truth about the creation of the human being - man and woman - in the image and likeness of God. This is not a purely theoretical interpretation, nor an abstract definition, for it gives an essential indication of what it means to be human, while emphasizing the value of the gift of self, the gift of the person (John Paul II, 1988, p. 62). For the Pope, a crucial aspect of human nature is that it is given to us as a gift and bears the structure of gift within it such that the fulfillment of the human being is to give himself to another in love. This “other” is most principally God, but as Christ teaches, love of God and love of neighbor cannot be separated (Mk 12:30-31, Jn 13:34, 1 Jn 4:21). Moreover, human nature is an embodied nature, one that always exists in the duality of the sexes. The human being is either a man or a woman, and this difference is irreducible. The two sexes constitute two fundamentally different ways of being human. This sexual difference does not merely affect the physical features of the body but conditions the human person in the deepest way, thereby affecting his entire body-soul composite. However, it does not follow from this that one sex is superior to the other. Rather, they are complementary. The sexual difference enables man and woman to give themselves totally to each other and receive each other as gift in marriage. This self-giving love is a fruitful love that opens to the blessing of children. Through this communion made possible by man’s sexual body, the human family bears an image of the communion of the Father, Son, and Holy Spirit in the one ineffable divinity. Because of the constitutive nature of the sexual difference and man’s vocation to be a gift for another, man and woman reach their fulfillment in and through fatherhood and motherhood. Therefore, the Pope states, This truth about the person also opens up the path to a full understanding of women’s motherhood. Motherhood is the fruit of the marriage union of a man and woman, of that biblical “knowledge” which corresponds to the “union of the two in one flesh” (cf. Gen 2:24). This brings about - on the woman’s part - a special “gift of self”, as an expression of that spousal love whereby the two are united to each other so closely that they become “one flesh”…. This mutual gift of the person in marriage opens to the gift of a new life, a new human being, who is also a person in the likeness of his parents. Motherhood implies from the beginning a special openness to the new person: and this is precisely the woman’s “part”. In this openness, in conceiving and giving birth to a child, the woman “discovers herself through a sincere gift of self”. The gift of interior readiness to accept the child and bring it into the world is linked to the marriage union, which - as mentioned earlier - should constitute a special moment in the mutual self- giving both by the woman and the man. According to the Bible, the conception and birth of a new human being are accompanied by the following words of the woman: “I have brought a man into being with the help of the Lord” (Gen 4:1). This exclamation of Eve, the “mother of all the living” is repeated every time a new human being comes into the world. It expresses the woman’s joy and awareness that she is sharing in the great mystery of eternal generation (John Paul II, 1988, p. 63, underline added). 2 Motherhood, then, has a special importance for the woman because it is inscribed in her very being and flows out of her mutual self-giving with her husband. Her femininity makes her apt to receive her husband’s self-gift and also to receive the new life that God may give as the fruit of their loving communion. The woman’s call thus entails giving herself in a bodily way not only to her husband but to their children as well. Her fulfillment as a human being is always tied in some way to motherhood. [3] Because of the woman’s special aptitude to receive new life and her calling to give herself in a bodily way to this life, there forms an intense bond between mother and child from the very moment of conception.